Kirsty Roy (Kirsty.Roy@scieh.csa.scot.nhs.uk)
and Sarah Wadd on behalf of the BBV and STI unit, Scottish Centre for Infection
and Environmental Health and the Scottish National Gonorrhoea Reference Laboratory,
Edinburgh, Scotland.

Genital herpes simplex infection
In 2002, 940 infections were isolated; this figure compares with 1033 in
2001 and annual averages of 955 for 1999-2002, 791 for 1995-1998 and 666
for 1992-1994 (Table 1). Between the early and late 1990s, almost all of
the increase in herpes simplex incidence was due to rising rates among women.
In 2002, 26% of infections were isolated from persons aged under 25 years;
the corresponding rate for 1992 was 31%.

Genital chlamydia
In 2002, 12 392 isolates were reported to SCIEH, a 16% increase on the previous
year’s total (10 636), and a 62% increase on that recorded for 2000 (7654)
(Table 2). As with genital herpes simplex infection, the gender distribution
favours women; in 2002, they represented 71% of all infections isolated.
Genital chlamydia is an infection which predominates in young people; in
2002, 52% of all infections were isolated from persons under the age of
25. The dramatic increase in the incidence of genital chlamydia diagnoses
throughout Scotland over the last decade is demonstrated by comparing rates
for 1992 with those for 2002 (Figure).

Gonorrhoea
In 2002, 821 episodes of gonorrhoea were reported to SCIEH; this figure
compares with 817 in 2001 and annual averages of 217 for 2000-2002, 139
for 1995-1999, and 172 for 1992-1994 (Table 3). Unlike for genital herpes
simplex and genital chlamydia infections, the majority of cases are in men.
The annual average number of male cases increased by 219% from 278 in 1992-1994
to 609 in 2000-2002; the corresponding increase among women was 25% (172
to 216). The considerable increase in gonorrhoea among men, seen in the
late 1990s, is considered to be largely due to transmission among men who
have sex with men (MSM). This is corroborated by the increase in rectal
isolates of gonorrhoea from 34 in 1999 to 54 in 2000, 53 in 2001 and 78
in 2002 (2). In 2002, 67% of episodes of infection among women occurred
in those under 25 years; the corresponding rate for men was 35%.

*Includes cases where gender is not known. One episode of gonorrhoea
corresponds to an infected individual from whom more than one isolate could
have been recovered.

ConclusionInfections among heterosexuals
Because laboratory reports contain no information about sexual orientation,
it is impossible to know whether infections in males are occurring within
a certain group, for example heterosexuals, or MSM. Analysis of STI rates
among women provides the best gauge of infection among heterosexual populations
as a whole. Trends in herpes simplex and gonorrhoea among women should be
considered true reflections of any changes in high risk sexual behaviour
among heterosexual populations. Evidence suggests that there has been a
modest increase in STIs among heterosexuals in Scotland in recent years.

The interpretation of trend data for genital chlamydia is difficult because
chlamydia is often an asymptomatic infection, which is diagnosed through
screening. Accordingly, increases in the numbers of genital chlamydia diagnoses
are as likely to be due to changes in screening practice as to increases
in the incidence of infection. Although it is not known whether the incidence
of genital chlamydia infection has increased in recent years, there is no
doubt that very large numbers of people, young adults in particular, are
infected. Such data indicate that casual unprotected sexual intercourse
among young heterosexuals remains a major problem in Scotland.

Infections among MSM
For MSM, the increase in rectal gonorrhoea is worrying and is consistent
with the recent increase in the incidence of syphilis in this population.
In 2002, there were 31 cases of syphilis among gay men, mainly in Edinburgh
and Glasgow. These observations are of great concern as gay men are at high
risk of acquiring HIV infection.

Acknowledgements
SCIEH wishes to thank Joan McElhinney at the SNGRL for help with database
maintenance and analysis, as well as the Consultant Microbiologists and
their staff who supply data to the SNGRL and SCIEH.

Disclaimer: The opinions expressed by authors contributing to Eurosurveillance do not necessarily reflect the opinions of the European Centre for Disease Prevention and Control (ECDC) or the editorial team or the institutions with which the authors are affiliated. Neither ECDC nor any person acting on behalf of ECDC is responsible for the use that might be made of the information in this journal. The information provided on the Eurosurveillance site is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her physician. Our website does not host any form of commercial advertisement. Except where otherwise stated, all manuscripts published after 1 January 2016 will be published under the Creative Commons Attribution (CC BY) licence. You are free to share and adapt the material, but you must give appropriate credit, provide a link to the licence, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.